Provider Demographics
NPI:1366591265
Name:TAYAPONGSAK, PAIROT (DMD)
Entity type:Individual
Prefix:DR
First Name:PAIROT
Middle Name:
Last Name:TAYAPONGSAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 NORMANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-6211
Mailing Address - Country:US
Mailing Address - Phone:904-786-9200
Mailing Address - Fax:904-786-1116
Practice Address - Street 1:7101 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6211
Practice Address - Country:US
Practice Address - Phone:904-786-9200
Practice Address - Fax:904-786-1116
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN122151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery